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Rotten teeth warning hits young smokers hardest 15 September 2004 By KELLY ANDREW Pictures of yellow, rotting teeth and a diseased brain have more impact on young smokers than the written warnings on cigarette packs, new research shows. The Massey University study asked 300 smokers and non-smokers aged between 18 and 23 for their reaction to five images, including a picture of a brain after a stroke, rotting teeth, a drooping cigarette with the slogan "Hard Men Don't Smoke", and a cigarette with a fish hook and the words "Bait from the Tobacco Industry". They were also shown a text-only "Smoking Kills" health warning used on cigarette packets. Study co-author Janet Hoek, from the university's marketing department, said the findings suggested images elicited stronger reactions from both smokers and non-smokers. Pictures were more effective in promoting quitting behaviours among smokers than the text-only message. Fear-evoking graphic images, such as the rotten teeth and the brain, were rated more disturbing, more attention-grabbing, and more credible than the others. However, Professor Hoek said this could be a short-term shock response and the effect of these pictures could "wear out", while the other more intellectual messages might become more resonant over time. About 25 to 30 per cent of smokers said the medical images could prompt them to phone Quitline, and about a third said they might lead them to cut back on cigarettes. Reactions to the pictures was similar between smokers and non-smokers, though the bait image produced a weaker response from non-smokers, possibly because they had less first-hand experience of addiction. Professor Hoek said the drooping cigarette image was one of the least effective options with smokers, possibly because it related to a long-term problem - impotence - which might not be relevant to young smokers. Several countries, including Canada and Brazil, have introduced gory pictures on cigarette packets. In New Zealand, the Health Ministry has developed a consultation document looking at the effectiveness of different types of warnings, including pictures. The final analysis is expected next month. Pictorial warnings are recommended under the World Health Organisation's Framework for Tobacco Control which New Zealand is helping develop.